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Home / Health Insurance / Critical Illness Insurance

Critical Illness Insurance

Critical Illness Insurance: An Important Safety MeasureCritical Illness Insurance: An Important Safety Measure

Critical Illness Insurance provides coverage against life-threatening health conditions such as cancer, heart attack, kidney failure, etc. It ensures that your savings don’t get affected during the time of an emergency. These kinds of diseases usually affect major parts of your body and generally require an on-going treatment, which can put a lot of financial burden on the family. Hence, it is very important to get these critical illnesses covered under a health insurance plan, which will stop you from spending all your savings and help you focus on your health without any stress. HDFC ERGO’s Critical Illness Insurance Cover will be your perfect partner during difficult times, with lower premiums and bigger coverage to assist you with better financial planning.

Features of Critical Illness Insurance Plans

  • Covers over 15 critical health conditions: A critical illness usually affects a major organ or part of body which can have a huge impact on your overall wellbeing, such as heart attack, kidney faliure, paralysis, brain tumour etc. Such illnesses can take a huge toll on your finances and the treatment can cost you a fortune. With HDFC ERGO’s Critical Illness Plan, you can safeguard yourself from 15 such critical illnesses and ensure financial support in times of need.
  • Tax benefits:A critical illness plan not only gives you financial support during hospitalisation and treatment, it also helps you to save tax and plan your savings as provides tax benefits under Section 80D of the Income Tax Act 1961.
  • Affordable premiums: While the cost of your hospital bills and treatments can be skyrocketing if you suffer from any kind of critical illness, you can secure your health and finances too by getting critical illness cover at affordable premiums for bigger coverage. You can choose from HDFC ERGO’s Critical Illness Plans and stay guarded against any such emergency.
  • Hassle free claim process: We ensure that one doesn’t have to run pillar to post amidst hospital visits and prolong treatment, so our claim processes are made simple and hassle free to help one avail the services at ease while getting treated and healing at peace.

4 Reasons To Choose HDFC ERGO’s Critical Illness Policy

Upto 15 Critical Illnesses covered

Upto 15 Critical Illnesses covered

The bigger the health coverage, the lesser stress for you and that is exactly what we are offering – coverage of wide range of illnesses in a single plan.

Lump Sum payment in a single transaction

Lump Sum payment in a single transaction

To save you from additional worry and time required to check with the insurance company about money clearances, we pay the sum insured in a single transaction.

Comprehensive plans

Comprehensive plans

We are offering two wide-ranging plans. Find the plan that best matches with your needs.

Option to buy for 1 & 2 Years

Option to buy for 1 & 2 Years

The plans are available for one or two years with the option of easy renewals.

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Understand Coverage Offered by Our Critical Illness Insurance

Financial Security

Financial Security

Your treatment will have little or no impact on your hard-earned savings as the insurance will take care of the hospital bills.

Quality medical treatment

Quality medical treatment

You won’t have to worry about not being able to afford the medical expenses at quality hospitals. Courtesy the insurance, you can get the best treatment available to help you recover.

Free Look Period

Free Look Period

We provide a free look period of 15 days starting from the date of receipt of the policy document.

No Medical Check-ups

No Medical Check-ups

No medical check-ups up to the age of 45 years.

Tax saving under section 80D

Tax saving under section 80D

Taking this critical illness cover will also give you tax benefits and you can save tax up to ^^Rs. 50,000.

Lifetime Renewability

Lifetime Renewability

The policy can be renewed for a lifetime period.

Adventure sport injuries

Adventure sport injuries

Adventure sports can be exciting, but if you meet with an accident, while participating in them, they can be hazardous. Our policy does not cover accidents encountered while participating in adventure sports.

self-inflicted injuries

Self-inflicted injuries

You might think of causing injury to yourself, but we don’t want you to get hurt. Our policy does not cover self-imposed injuries.

War

War

Wars are disastrous and unfortunate. However, our policy does not cover any claims that are caused due to wars.

Participation in defense operations

Participation in defense operations

Our policy does not cover accidents while you are participating in defense (Army/Navy/Air Force) operations.

 Sexually transmitted diseases

Sexually transmitted diseases

We do understand the critical nature of your disease. However, our policy does not cover venereal or sexually transmitted diseases.

Obesity or cosmetic surgery treatment

Obesity or cosmetic surgery treatment

Treatment of obesity or cosmetic surgery is not eligible for coverage under your insurance policy.

Critical Illness Insurance Plan vs. Health Insurance Plan

We are living in some crazy times. On one hand, when awareness of health and fitness is reaching every nook and corner of the country, on the other hand, the number of people suffering from lifestyle and non-communicable diseases is increasing. At times, such conditions can lead to hospitalisation and treatment that can cost one dearly, depleting one’s savings and disrupting finances. Health insurance in such a scenario comes in handy for paying off hospital bills, getting cashless treatment in network hospitals, cover cost of procedure, treatment after an accident and other conditions mentioned in the policy. However, a health insurance policy doesn’t cover all the diseases and usually has a long waiting period.

Features Health Insurance Plan Critical Illness Insurance Plan
Coverage It provides coverage for a variety of incidents like accidents, diseases, pre-existing diseases, etc. Offers coverage for a limited number of serious diseases. The number of such illnesses covered depends upon the insurance company.
Benefits Cashless treatments, additional coverage options, coverage for multiple family members, etc. are offered. Once the policyholder is diagnosed with a specified critical illness, the coverage amount is paid.
Premium It depends on the insurance company, coverage offered; members covered, and amount of sum insured of the policy. Depends on the insurance company, the number of diseases covered, and sum assured of the policy.
Survival period NA This is the time period for which the policyholder must survive after the date of diagnosis. It ranges from 14 to 30 as per the policy.
  • For instance, imagine a person A who has taken a health insurance policy and has been paying his premium on time every year gets diagnosed with a life-threatening diseases like cancer or kidney failure. His health insurance policy might not cover him for that particular disease.But if he had taken a critical illness policy in addition to his health insurance policy, he could claim a lump sum amount after the diagnosis of any life-threatening disease as mentioned in the policy.
  • So, both health insurance policy and critical illness policy provide a wide range of coverage and have their own benefits. Both are critical for one’s well being and cannot undermine the importance of the other. It is better to have a good health insurance policy and critical illness policy separately to avail their benefits in time of need.

Advantages of Critical Illness Insurance

Having critical illness insurance will give you an added advantage in securing your health and wellbeing. Here are some advantages of the same.

  • Provides coverage for life-threatening illnesses: Unlike your standard health insurance policy, critical illness policy will cover you for life-threatening diseases like cancer, brain tumor, kidney failure, paralysis, which might not fall under the umbrella of a standard health insurance policy. Paying a premium in time for a critical illness policy, you can rest assured of getting financial support during a medical emergency.
  • Provides tax benefits: A critical illness plan cover provides tax benefits under section 80D and also during the claims one receives a tax-free lump sum amount.
  • Provides a lump sum for treatment: The advantage of the critical illness policy is that it gives you a lump sum during the claim that will help you spend the amount the way you want to manage your expenses during the treatment. cover at affordable premiums for bigger coverage. You can choose from HDFC ERGO’s Critical Illness Plans and stay guarded against any such emergency.
  • Provides easy access to claims: During the claim one will not need to provide bills and other documents as done during a claim for a standard health insurance policy. Only proof of the diagnosis of the illness can help.
  • Provides with less waiting period: A critical illness policy usually has a reduced waiting period and a claim can be placed as soon as the wait period is over.

Factors To Consider Before Buying Critical Illness Insurance

1

Current Situation

You need to be practical when you are thinking of purchasing a critical illness policy. Some of the things to consider are family structure, your present age and your dependents, especially old parents. If you have senior citizens and family as dependents, it can be assumed that you need extra coverage for sudden healthcare emergencies like heart attacks etc. A critical illness policy will be a safety net for your loved ones during uncertain times and not put burden on your financial savings. Hence opt for a critical illness policy that will offer you sufficient financial support and not affect the other needs of your family.

2

Health Condition

Your present health status may be an important deciding factor whether you should buy a critical illness policy or not. People who are regular smokers, have a high-stress job, are more at risk to health problems in the future. Therefore, it is always advisable to start planning early so that there are lesser obstacles in the future while buying insurance.

3

Financial Position

Presently, whether you earn well or not, you need to think about the future when planning to buy a critical illness policy. You must remember that healthcare costs are constantly increasing and further inflation in the healthcare sector is bound to happen. Therefore, keep all these factors in mind before deciding on the sum assured.

4

Wide Coverage

Even though a critical illness insurance might not be your primary health insurance plan, you need to choose it carefully. Hence before selecting a policy, read and know about the list of illnesses covered to know if most critical conditions will be covered by the insurer. Also, read the terms and conditions thoroughly to know the exclusions in the policy.

5

Supports your Health Insurance Policy

When selecting your critical illness insurance, make sure it balances your health insurance policy, so that you get maximum coverage at a reasonable price. Together, both policies should cover all aspects of health care so that your stress regarding healthcare is reduced.

Who Should Buy Critical Illness Cover

People with high-pressure jobs

Critical illnesses have a high association with high-pressure jobs. Many studies have stated that people working in high-pressure work environments are at higher risk of having a critical illness. Hence, people having a job where they have a lot of pressure on them, should definitely buy a critical illness policy.

People over 40 years of age

Once you cross 40 years, you are more at risk to developing critical illnesses. It is practical to buy a critical illness insurance policy when you are in your late 30s. Moreover, people are most likely to be in a better financial position and can pay policy premium easily.

People with family history of critical illness

There are critical illnesses that are hereditary. A person has maximum chances of developing a critical illness if it runs in their family. So, it is essential to take precaution in advance and therefore, people who have a history of critical illnesses in their family should definitely buy a critical illness insurance.

Also Read : Family medical history & impact on your health insurance

Why Should You Buy a Critical Illness Cover Even If You Already Have a Mediclaim Plan?

A lot of people think that they do not require critical illness cover if they already have a medical insurance policy. Most of them consider mediclaim policy and critical illness cover to be the same. However, this is factually incorrect.

In critical illness policy, the benefit that will be allotted to you in lieu of the policy is a one-time benefit. So it can be used once and in an extreme situation where the treatment cost is very high. Critical illness policy is appropriate for situations where you will be required to pay a huge sum in a considerably shorter period of time for disease that may not be covered in your health insurance.

Mediclaim policy covers an individual against the cost of pre and post-hospitalization even if it is for minor illness or injuries (unless it is not covered under the medical insurance policy). But if the policyholder is diagnosed with any major disease which may require prolonged hospitalization then critical illness policy will be more suitable for the individual’s treatment. It provides for cost for treatment and subsequent care taking, loss of income and change in lifestyle in a lump sum amount.

How to Make a Claim for your HDFC ERGO Critical Illness Health Insurance Policy

Intimate us
1

Intimate us

Fill up the pre-auth form at the network hospital for cashless approval

Approval/Rejection
2

Approval/Rejection

Once hospital intimates us, we send you the status update

Hospitalization
3

Hospitalisation

Hospitalisation can be done on the basis of pre-auth approval

 claims settlement
4

Claim settlement

At the time of discharge, we settle the claim directly with hospital

We settle reimbursement claims within 6~* hours

Hospitalization
1

Hospitalisation at non network hospital

You need to pay the bills initially and preserve the original invoices

claim registration
2

Register a claim

Post hospital discharge send us all your invoices and treatment documents

claim verifcation
3

Verification

We verify your claim related invoices and treatment documents

claim approval
4

Claim Settlement

We send the approved claim amount to your bank account.

Save Tax with Critical Illness Insurance Policy

Dual Benefit

A critical illness health insurance policy not only covers your medical expenses but also offers tax benefits so that you can save upto ₹ 1 lac**** under Section 80D of Income Tax Act 1961. It plays an important role in planning your finances.

Tax deduction based on medical insurance premium paid

By getting yourself a critical illness cover, you can get a deduction of up to ₹ 25,000 per budgetary year for medical insurance premium under Section 80D of Income Tax Act 1961.

Deduction on preventive health check-ups

You can also claim tax benefits on preventive health check-ups annually under Section 80D of the Income Tax Act. You can claim up to ₹ 5,000 every budgetary year as expenses incurred for preventive health check-ups.

Deduction on medical insurance premium paid for parent

If you are paying the medical insurance premium for guardians, then you can also claim an additional deduction of up to ₹ 25,000 every budgetary year. If your parents or either of them is a senior citizen, then this limit can go up to ₹ 30,000.

Please note that the above-mentioned benefits are as per the current tax laws prevailing in the country. Your tax benefits may change subject to tax laws. It is advisable to reconfirm the same with your tax consultant. This is independent of your health insurance premium value.

What are the Documents Required at the Time of Critical Illness Insurance Claim?

Following documents are needed for filing claims:

• ID Proof of the applicant

• Claim form (duly filled & signed)

• Copy of hospital summary, discharge papers, prescription, medical reference, etc.

• Copy of medical reports, records

• Doctor’s certificate

• Any other relevant document as requested by the Insurer

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Want to Buy Critical Illness Insurance Plan?

Should you buy an add-on rider or separate policy?

While buying a health insurance policy for critical illness weigh your options well. You can either choose to buy a stand-alone critical illness cover or opt for a rider option. A stand-alone policy provides comprehensive cover as compared to riders. However, an add-on rider too comes with its own advantages. There are two kinds of rider policy - A Comprehensive Critical Illness Rider and Accelerated Critical Illness Rider. In the Comprehensive Critical Illness Rider an additional cover amount is added, in addition to your term plan cover. If there is a claim, this amount will be paid, while keeping your base term insurance cover 100% intact. However, in an Accelerated Critical Illness Rider, a part of the base cover is paid as an advance from the base sum assured in case of a claim and the base insurance cover will be reduced by an equal amount. It is better to weigh your pros and cons and have a healthy discussion with your health advisor before investing in a rider or separate policy.

What's More

Family
Family

Unveils Plans for Family

Parents
Parents

Check our Plans for Parents

Senior Citizens
Senior Citizens

Growing Medical Needs

Women
Women

Get Lump Sum Benefits for Women Specific Critical Illnesses

Health Insurance Reviews & Ratings

4.4/5 Stars
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Our customers have rated us

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DEVENDRA KUMAR

EASY HEALTH

5 June 2023

BENGALURU

Very nice services, keep it up. Best wishes to team members.

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G GOVINDARAJULU

HDFC ERGO GROUP HEALTH INSURANCE

2 June 2023

COIMBATORE

My sincere thanks to your customer service executive Ms Meri who has helped me uploading the claims on your website.Her knowledgeable guidance was very helpful. Such help is very much appreciated for Senior Citizen like us. Thank you once again

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RISHI PARASHAR

OPTIMA RESTORE

13 Sep 2022

DELHI

Excellent service, nothing to complain about. You are number one in terms of service. My uncle suggested me to purchase insurance from you and I am very happy

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VASANT PATEL

MY:HEALTH SURAKSHA

12 Sep 2022

GUJARAT

I have a policy with HDFC and it has been a great experiense with HDFC team.

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SHYAMAL GHOSH

OPTIMA RESTORE

10 Sep 2022

HARYANA

The excellent services have helped me feel mentally very secured and at peace while undergoing treatment for these life threatening disease. Looking forward to the same excellent service in the future as well.

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Nelson

Optima Secure

10 Jun 2022

Gujarat

Thanks for calling me. The customer care executive was very articulate and systematic about various products of HDFC Ergo Health Insurance. It was great talking to her.

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A V Rammurty

Optima Secure

26 May 2022

Mumbai

Thanks for calling me and explaining to me in great detail the various features of Optima Secure and Energy Health Insurance Policies. The customer service executive was very articulate, systematic, and knowledgeable about various products of HDFC Ergo Health Insurance. It was great talking to him.

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Frequently Asked Questions Related to Critical Illness Insurance

Critical Illness Insurance is a policy that pays out a lump sum amount upto the sum insured upon diagnosis of a critical illness covered under the policy.

If god forbid you are diagnosed with a critical illness, the cost of treatment can weigh you down and if you are planning to buy a critical illness policy, you need to plan it right. Remember it might take some years for you to recover from a critical illness and you should be prepared to support yourself financially till then. So, to calculate how much critical benefit you need, you need to consider the following factors:

  • 1. Your monthly expenses: If your monthly expenses are Rs 1 lakh a month, then in 5 years you will need at least Rs 60 lakhs
  • 2. Your liabilities: If you are paying an EMI of suppose Rs 40,000 you will need to pay an amount of Rs 24 lakhs in 5 years
  • 3. Other source of income: Suppose you make a decent 20k from a side hustle in the next 5 years, it can amount to Rs 12 lakh
  • 4. Cost of the treatment: This could range from 25 to 35 lakhs for any kind of critical illness for a 5-year recovery period. Lets take this as Rs 25 lakhs.
  • 5. Emergency funds: Funds that you have saved and can come in handy. Let’s say you have Rs 5 lakhs saved. Now add all these amounts and multiply them by 1.5, keeping the inflation rate in mind. The total amount will be the amount you need. So plan accordingly. Alternatively, you can use a critical illness insurance calculator or have a chat with your financial advisor.

Ideally, you get a lump sum assured in a critical illness policy after the first diagnosis. If you are already diagnosed with the illness, unfortunately, you won’t be able to avail yourself of the benefit of a critical care insurance policy.

Under a benefit policy on happening of an insured event, the insurance company pays the policyholder a lump sum amount.

The company will pay the sum insured as lump-sum on first diagnosis of any of the Critical Illnessess stated in the policy, provided that the insured person survives a period of 30 days from the date of the first diagnosis. The following Critical Illnesses are covered under our plan:- 1. Heart Attack (Myocardial Infarction) 2. Coronary Artery Bypass Surgery 3. Stroke 4. Cancer 5. Kidney Failure 6. Major Organ Transplantation 7. Multiple Sclerosis 8. Paralysis

You can choose from sum insured ranging from Rs. 5 lacs Rs. 7.5 lacs and Rs. 10 Lacs.

Critical Illness policy covers individuals in the age group of 5 years to 65 years.

No pre-policy medical check up is required for individuals upto 45 years.

The best part of this policy is that you do not require to submit any documentation. Simply fill the details online and make payment via multiple secured payment modes. In case of a pre-existing disease, you might have to submit relevant medical documents.

You can avail upto ^^Rs.50,000 as tax benefit under 'Section 80 D'.

Any condition, ailment or injury or related condition(s) for which insured person had signs or symptoms and/or was diagnosed and/or received medical advice/treatment within 48 months prior to your first policy with the company is termed as pre-existing diseases.

Disease means a pathological condition of a part, organ, or system resulting from various causes, such as infection, pathological process, or environmental stress, and characterized by an identifiable group of signs or symptoms.

No, you can make only one claim during the lifetime of the critical illness insurance.

In case of a claim under the Policy, you should immediately intimate us on our helpline numbers. On receipt of the intimation, we would register the claim and assign a unique claim reference number which would be communicated to the Insured which may be used for all future correspondence.

Critical Illness Insurance Plans refers to the coverage against Specified major medical illnesses or diseases. The management of these critical illnesses requires long term care. Apart from the hospitalization costs, there will be other expenses like doctor visit fees, other medical expenses, rehabilitation and much more. Under Critical Illness plan a lump sum amount i.e. the Sum Insured is paid, which can be used to cover these expenses. This lump sum amount is in addition to any of your indemnity health insurance policy.

The Policy pays the sum insured as lump-sum on first diagnosis of any of the Listed Critical Illnesses stated in the policy after a waiting period and provided that the insured person survives a period as specified in the policy from the date of the first diagnosis of the Critical illness.

The following 8 Critical Illnesses are covered under Silver plan of our Critical illness policy:- 1. Myocardial Infarction (First Heart Attack of specified severity) 2. Open Chest CABG 3. Stroke resulting in permanent symptoms 4. Cancer of specified severity 5. Kidney Failure requiring regular dialysis 6. Major Organ Transplantation 7. Multiple Sclerosis with Persisting Symptoms 8. Permanent Paralysis of Limbs

Platinum Plan covers a total of 15 critical illnesses. In addition to above mentioned illnesses, this plan covers:- 9. Surgery of Aorta 10. Primary (idiopathic) Pulmonary Hypertension 11. Open Heart Replacement or Repair of Heart Valves 12. Benign Brain Tumor 13. Parkinson’s disease 14. Alzheimer’s Disease 15. End Stage Liver Failure

HDFC ERGO Critical Illness insurance policy has a waiting period of 90 days.

Critical Illness Insurance provides you and your family an additional financial security on diagnosis of a critical illness. The policy provides a lump sum amount which can be used for: costs of the care and treatment, recuperation aids, debts pay-off, any lost income due to a decreasing ability to earn and for a change in lifestyle.

You can choose from sum insured ranging from Rs. 5 lacs, Rs. 7.5 lacs and Rs. 10 lacs.

Critical Illness cover can be offered only to Individual with No past medical history of critical illness. For more information, read the policy document.

No, you can make only one claim during the lifetime of the critical illness insurance.

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